A 61-year-old man presented with difficult swallow... His dysphagia localized to neck, without associated odynophagia, nasal regurgitation and cough... He had no other significant medical history... Localization to neck is not specific for an oropharyngeal dysphagia, because about 30% of patients with distal esophageal obstruction perceive the obstruction to be in the cervical esophagus... HRM showed normal esophageal peristalsis... However, when compared with a healthy 61-year-old subject (Fig. 1A), there were shorter upper esophageal sphincter (UES) relaxation and elevated intrabolus pressure proximal to UES in the patient (Fig. 1B)... Neck CT showed prominent cervical osteophytes including C5 and C6 (Fig. 2A)... A further videofluoroscopic swallowing study demonstrated reduced UES opening and moderate amount of pharyngeal residue (Fig. 2B)... Given together, the patient had elevated intrabolus pressure gradient across the cervical osteophytes... Cervical osteophytes usually are clinically silent but can cause dysphagia, stridor, neurologic problems, and even aspiration when they are larger than 10 mm... They are seen mainly in older patients.

Mentions:
Localization to neck is not specific for an oropharyngeal dysphagia, because about 30% of patients with distal esophageal obstruction perceive the obstruction to be in the cervical esophagus.1 Therefore we performed high-resolution manometry (HRM; ManoScan, Sierra Scientific Instruments, Los Angeles, CA, USA) for the evaluation of difficult swallow. HRM showed normal esophageal peristalsis. However, when compared with a healthy 61-year-old subject (Fig. 1A), there were shorter upper esophageal sphincter (UES) relaxation and elevated intrabolus pressure proximal to UES in the patient (Fig. 1B). Interestingly, worsening change of the elevated intrabolus pressure was noted during multiple rapid swallow using 100 mL water (Fig. 1C). This finding suggested cricopharyngeal achalasia. We performed further neck CT to evaluate a cause of cricopharyngeal achalasia. Neck CT showed prominent cervical osteophytes including C5 and C6 (Fig. 2A). A further videofluoroscopic swallowing study demonstrated reduced UES opening and moderate amount of pharyngeal residue (Fig. 2B). Given together, the patient had elevated intrabolus pressure gradient across the cervical osteophytes. Cervical osteophytes usually are clinically silent but can cause dysphagia, stridor, neurologic problems, and even aspiration when they are larger than 10 mm.2 They are seen mainly in older patients.

Mentions:
Localization to neck is not specific for an oropharyngeal dysphagia, because about 30% of patients with distal esophageal obstruction perceive the obstruction to be in the cervical esophagus.1 Therefore we performed high-resolution manometry (HRM; ManoScan, Sierra Scientific Instruments, Los Angeles, CA, USA) for the evaluation of difficult swallow. HRM showed normal esophageal peristalsis. However, when compared with a healthy 61-year-old subject (Fig. 1A), there were shorter upper esophageal sphincter (UES) relaxation and elevated intrabolus pressure proximal to UES in the patient (Fig. 1B). Interestingly, worsening change of the elevated intrabolus pressure was noted during multiple rapid swallow using 100 mL water (Fig. 1C). This finding suggested cricopharyngeal achalasia. We performed further neck CT to evaluate a cause of cricopharyngeal achalasia. Neck CT showed prominent cervical osteophytes including C5 and C6 (Fig. 2A). A further videofluoroscopic swallowing study demonstrated reduced UES opening and moderate amount of pharyngeal residue (Fig. 2B). Given together, the patient had elevated intrabolus pressure gradient across the cervical osteophytes. Cervical osteophytes usually are clinically silent but can cause dysphagia, stridor, neurologic problems, and even aspiration when they are larger than 10 mm.2 They are seen mainly in older patients.

A 61-year-old man presented with difficult swallow... His dysphagia localized to neck, without associated odynophagia, nasal regurgitation and cough... He had no other significant medical history... Localization to neck is not specific for an oropharyngeal dysphagia, because about 30% of patients with distal esophageal obstruction perceive the obstruction to be in the cervical esophagus... HRM showed normal esophageal peristalsis... However, when compared with a healthy 61-year-old subject (Fig. 1A), there were shorter upper esophageal sphincter (UES) relaxation and elevated intrabolus pressure proximal to UES in the patient (Fig. 1B)... Neck CT showed prominent cervical osteophytes including C5 and C6 (Fig. 2A)... A further videofluoroscopic swallowing study demonstrated reduced UES opening and moderate amount of pharyngeal residue (Fig. 2B)... Given together, the patient had elevated intrabolus pressure gradient across the cervical osteophytes... Cervical osteophytes usually are clinically silent but can cause dysphagia, stridor, neurologic problems, and even aspiration when they are larger than 10 mm... They are seen mainly in older patients.